The first step to having your vision corrected by refractive surgery, such as LASIK (which is the most common form of elective corrective eye surgery) is to book a comprehensive eye exam. A consultation will help determine your candidacy for the various refractive eye surgery options available, but specifically which surgical option is best for your particular vision deficit.
When you book a laser eye surgery consultation with Dr. Sciberras, you will likely be instructed to avoid wearing your contact lenses in the days or weeks leading up to it. This is so the optometrist can measure the true shape of your eye without it being reshaped by the contact lenses. This is particularly important in the weeks that lead up to a surgical date. The general rule is 1 week for a soft contact lens wearer and 1 week for every decade of wear for patients using hard (ie. rigid gas permeable) lenses.
During the consultation, you will discuss a number of things with your optometrist and a few simple tests will be performed not usually done in a routine eye exam. Specifically, these tests include corneal topography and corneal thickness (aka pachymetry), as well as a dilated retinal exam and a second check of your prescription after being dilated. Dr. Sciberras will take a full case history to better understand your medical and ocular history to highlight any conditions that may make you ineligible for eye surgery. These include autoimmune diseases, moderate to severe dry eyes, ocular herpes, cataracts, and lifestyle factors such as vocation and hobbies. We will also discuss your visual expectations post-surgery to ensure they are realistic. For example, the desire to never wear glasses again may be impossible, as eyes naturally lose the ability to focus up close as we age and you may need reading glasses even after your procedure or in the future.
Your ocular health will be assessed through a number of non-invasive procedures, primarily a slit lamp exam and/or digital retinal imaging. First and foremost, your overall eye health will be evaluated, as well as your prescription stability (i.e. how much has it changed since your last eye exam) and your binocular vision coordination. Specifically, your tear film will be evaluated to determine issues such as dry eye, as well as corneal pachymetry and corneal topography to measure the thickness and shape of your cornea, respectively. Pupil dilation is usually done at a follow-up visit, this is needed to relax the eye’s focusing ability so your prescription can be double checked. You’ll have the opportunity to ask as many questions as needed to ensure you are comfortable with the entire process.
If after the consultation, your examiner determines you are not a good candidate for LASIK, there may be an alternative refractive surgery option(s) for you, such as corneal ring implants or clear lens extraction. Some of these options will now be discussed.
Other Common Refractive Surgery Options
Intraocular Lenses (IOLs)
IOLs are manufactured lenses that are put inside the eye following cataract surgery (or in the absence of cataracts this is known as clear lens extraction). They are typically best for patients over the age of 50 who do not qualify for laser eye surgery, who have hyperopic prescriptions or that have the desire to be free from spectacles for near vision. The surgeon will replace the eye’s natural lens with an IOL after the natural lens is removed during this surgery. There are a variety of IOLs that can be used depending on the patient’s goals and current vision deficits.
Aspheric IOLs and toric IOLs are two of the most common types. Aspheric IOLs match the shape of the eye’s natural lens so they can provide sharper vision, especially for enhanced night vision or vision in dim light conditions, while toric IOLs are used to correct astigmatism that may be present pre-operatively.
Some implants are meant to work in conjunction with the eye’s natural lens. They are placed behind the iris, and in front of the eye’s natural lens. These inert lenses are best used for non-candidates of LASIK and for patients under the age of 40. This allows the patient to maintain their eye’s natural focusing ability, which generally diminishes after the age of 40.
PRK (Photorefractive Keratectomy) uses the same laser and reshaping process as in LASIK. It differs, however, in how the cornea is prepared for the laser treatment. With PRK, the corneal epithelium is gently removed and the laser is applied to reshape the cornea and thereby changing its refractive (light bending capabilities). PRK does require longer healing time than LASIK, and ocular discomfort post-surgery can last several days until the corneal epithelium heals. PRK is best suited for patients with thin corneas and myopic prescriptions.
The SMILE procedure removes corneal tissue from a deeper area of the cornea as compared to LASIK, to help maintain corneal structural integrity and long-term vision stability for patients that have thinner corneas preoperatively. Most of the patients who were not candidates for LASIK in the past can now have their myopia (aka nearsightedness) corrected by the SMILE technique, allowing them to recover as quickly and comfortably as LASIK patients.
Corneal intacs are commonly used for keratoconus treatment. They are plastic polymer implants that are ring shaped and placed within the cornea. They work by flattening the steepest part of the cornea to reduce vision distortions. The procedure is reversible, meaning they can be removed or replaced if your prescription changes. With corneal intacs, a patient can see results as soon as one day after surgery, but you may still require contact lenses depending on your initial prescription.